Assimetrias na pesquisa em saúde, publicada na revista médica de moçambique / Asymmetries in health research, published in the revista médica de moçambique

A Revista Médica de Moçambique (RMM) foi a publicação científica oficial do Instituto Nacional de Saúde de Moçambique entre 1982 e 2010. Foi realizado um estudo descritivo retrospectivo dos artigos publicados na RMM com o objectivo de analisar as tendências de publicação em saúde em Moçambique. Metodologia: Para cada número daRMM publicado foram colhidos dadossobre a data de edição, o tipo de artigo, o local em que decorreu a pesquisa, afiliação do primeiro autor, os assuntos abordados por artigo e a forma de financiamento. Foram definidos três períodos: I (1982-1988), II (1993-1999) e III (2003-2010), tendo em conta as interrupções havidas na edição da revista. Resultados: A RMM publicou 28 números dos quais 3 não foram considerados para análise por serem suplementos contendo apenas resumos de comunicações apresentadas em Jornadas Nacionais de Saúde. Os 25 números analisados continham 177 artigos, dos quais 143 (80,7%) eram de pesquisa original. A maior parte dos trabalhos publicados foram realizados na Província de Maputo: 21 artigos no período I, 50 no período II e 12 no período III. Os primeiros autores dos artigos publicados na RMM eram pesquisadores do Ministério da Saúde e do Instituto Nacional de Saúde, também localizados em Maputo, tendo publicado 51 e 50 artigos, respectivamente. Os autores concluem que se registou um predomínio de pesquisas realizadas em Maputo, por autores provenientes de instituições localizadas também nesta Província. Os temas mais abordados foram as doenças parasitárias e a saúde materno-infantil. A RMM foi editada com frequência irregular, tendo o pico de produção ocorrido no período II. De modo a garantir regularidade na edição e qualidade científica os autores recomendam a criação de mecanismos de auto-sustentabilidade da revista

The Mozambican Medical Journal (MMJ) was the official publication of the National Health Institute between 1982 and 2010. We performed a retrospective study to evaluate the trends of health research publication by this journal. For each published journal we collected information on the date of edition, type of articles included, site of research described, affiliation of the first author, subject of research and how the edition was funded. Three periods were defined taking into account interruptions that occurred in the publication of the journal: period I (1982-1988), II (1993-1999) e III (2003-2010). The Mozambican Medical Journal published 28 editions; of these, 3 were not considered for analysis as they were supplements containing only abstracts of communications presented at the National Health Congress. The 25 editions considered for analysis had 177 articles of which 143 (80.7%) presented the results of original research. Maputo Province had the greater number of articles published: 21 during Period I, 50 during Period II and 12 in the last Period. First authors from the National Health Institute and the Ministry of Health, both located in Maputo, were in first and second place, publishing respectively 51 and 50 articles. It is concluded that there was asymmetry of the work published at the Mozambican Medical Journal, regarding authorship and place implementation of research. The vast majority of studies were performed in Maputo Province. Most published articles were the result of studies on parasitic diseases and maternal and child health. The editions of the Journal were irregular; the peak of publications was during Period II. There is need to find mechanisms to achieve regularity of editions and sustainability of this scientific journal.

[Surgical options in the palliative treatment of pancreatic cancer]. / L'approccio chirurgico nella palliazione del carcinoma pancreatico.

Pancreatic carcinoma is an aggressive disease and its prognosis is dismal. Patients present with an advanced stage of disease and only a small number of patients undergo resection with a curative intent; thus the 5 years survival rate is very low. Several improvements have been made in the surgical approach with a decrease in perioperative morbidity and mortality. Results offered by chemotherapy and radiotherapy remain unsatisfactory despite a number of new drugs and considerable advancements in irradiation techniques. Jaundice, pain and gastrointestinal obstruction are the main clinical problems to be dealt with in advanced patients. Surgical palliation still represents a widely preferred option but non surgical approaches appear promising. The Authors analyse the possible options in palliation for pancreatic carcinoma. The various surgical procedures for biliary by-pass are described. Hepaticojejunostomy is the operation of choice and offers the best results in terms of quality of life and time of palliation. A possible role for resective operation also in advanced cases has been proposed by some groups and is gaining wide acceptance in referral centres where low morbidity and mortality are now routine. Percutaneous and endoscopic approaches to jaundice represent a valid alternative in some patients with a low life expectancy and in those centres with a high experience. Gastrointestinal by-pass in symptom-free patients or advanced cases only is an unsolved dilemma. New approaches such as locoregional chemotherapy with curative or neoadjuvant intent are also described in this paper. Many chemotherapic agents have been tested in various settings and appear to offer promising results in palliation and also, in some cases, in downstaging tumors then amenable to resection. Pain control is a major aspect in management of advanced pancreatic carcinoma. Appropriate pain therapy has to be established in all patients in order to obtain a better quality of life. Various options are available such as intraoperative alcohol injection or CT guided percutaneous splanchnicectomy. Palliation in patients with pancreatic carcinoma is a major aspect of management because of the high percentage of non curable cases; multimodality approach is mandatory and all possible problems have to be dealt with in order to increase survival and, more importantly, quality of life.

[Aneurysms of the splanchnic arteries]. / Aneurismi delle arterie splancniche.

Although visceral aneurysms usually have an asymptomatic course, ruptures associated with high mortality do occur. When an asymptomatic lesion is found, the physician must decide whether it should be treated surgically and which surgical technique should be used. Because this type of aneurysm is relatively rare, the answer to these questions have not been determined previously. The outcome in 16 patients treated by surgical or embolization procedures was evaluated. A group of 16 patients with visceral aneurysms were observed in our institution between 1987 and 1993. Localization of aneurysms was on the splenic artery in 8 cases, renal artery in 4 cases, hepatic artery in 3 patients and superior mesenteric artery in one patient. Hypertension was related to renal aneurysms and angina abdominis to the patient with superior mesenteric artery aneurysm. Of the 16 patients, 8 (6 splenic and 2 hepatic aneurysms) were asymptomatic, 3 (2 splenic and 1 hepatic) were treated as an emergency because they presented with shock. In the splenic group (8 cases), 2 patients underwent embolization procedures with Gianturco's coils, and 6 surgical procedures; in the hepatic group 1 embolization and 1 surgical procedure were performed; and finally in the renal and mesenteric group surgical reconstruction was performed during aortic prosthetic surgery. Because of well documented natural history of progressive enlargement and eventual rupture, the aneurysms of visceral arteries should be corrected surgically when the diagnosis is confirmed by vascular imaging (ultrasounds, CT, RM, angiography). Ruptures are treated with emergency operations, when possible. In high-risk patients, non operative management by selective embolization (in case of splenic and hepatic aneurysms) may be suitable alternative.

[Primary intestinal tuberculosis]. / La tubercolosi intestinale primitiva.

Tuberculosis, with its pulmonary and extrapulmonary localizations, is rapidly increasing in Italy. The authors describe a case of a primary colonic tuberculosis in a 52-year-old Caucasian man. At admission the patient reported a 6-month history of constipation, weight loss and abdominal pain. He had rectal bleeding in the last two weeks. Haematological tests and chest X-ray were negative. Colonoscopy showed a stricture in the proximal transverse colon and multiple ulcers in the ileocecal tract. Multiple biopsies and culture demonstrated tuberculosis. The patient underwent a right hemicolectomy after an episode of acute intestinal hemorrhage and received pharmacological treatment for nine months. After four years he is still free of disease.

[Sacrococcygeal chordoma: clinico-radiologic and histologic characteristics]. / Cordoma sacrococcigeo: aspetti clinico-radiologici e istologici.

Chordoma is a rare, slow-growing, malignant tumor which usually localizes in the sacrococcygeal area. The authors report the case of a 36-year-old woman treated by sacral resection by a posterior approach. At admission, the patient reported a 5-month history of sacral pain. Digital rectal examination revealed a presacral mass. CT and above all MR revealed the presence and the precise extent of the mass which involved the last sacral vertebra and the coccyx. Diagnosis was confirmed histologically. Bilateral S-3 nerve roots were preserved. No radiotherapy was given. After 4 years the patients is free of disease.

[Cystadenoma of the pancreas: the clinical and preoperative diagnostic problems]. / Il cistoadenoma del pancreas: problemi di clinica e diagnosi preoperatoria.

Pancreatic cystadenomas must be considered in the differential diagnosis of all cystic neoplasms of the pancreas. On the basis of a clinical observation, the authors discuss the most important clinical and diagnostic findings of pancreatic cystadenomas with special regard for what concerns the mucinous type. The authors underline the extreme difficulty of a correct preoperative diagnosis and discuss, after a wide literature review, the utility and the validity of the various imaging, cytological and immunohistochemical preoperative diagnostic procedures. In most cases the final diagnostic confirmation comes from the histology on the resected specimen; therefore all cystic neoplasms, no matter their location within the gland, which are not clearly identified pre or intraoperatively, should be surgically treated and removed.

[The risk factors for liver and kidney complications in general surgery: the results of a prospective multicenter study]. / Fattori di rischio per le complicanze epatiche e renali in chirurgia generale: risultati di uno studio prospettico multicentrico.

A method for preoperative assessment of surgical risk, in function of several risk factors, was developed using the multiple logistic function, as a model of multivariate statistical analysis. This model has the advantage to express the two considered outcomes (perioperative complications and death) in numerical terms of probability. The data were obtained from 1182 consecutive patients, 14 yrs or more, admitted to six centres in various regions of Italy. Stepwise logistic regression model was applied to a set of preoperative and operative factors, three of which were found to significantly correlate with postoperative hepatic failure: compromission hepatic function time of surgical operation > 120' and nutritional status. The factors significantly correlate with postoperative renal failure were: compromission renal function, bacterial contamination during surgery, time of surgical operation > 120'.

[Manual and stapled sutures in digestive surgery: a comparative evaluation]. / Suture manuali e meccaniche in chirurgia digestiva: valutazione comparativa.

Results concerning 819 digestive sutures and anastomoses, 376 (45.9%) of which hand sewn and 443 (54.1%) stapled, are retrospectively analyzed. Comparative evaluation of the two techniques yielded better results for oesophageal and rectal anastomoses as well as duodenal stump closure mechanically performed. For intestinal anastomoses the two techniques showed similar results when performed in election, on the contrary, mechanical sutures fared significantly worse than hand-sutures in non elective surgery, with a morbidity of 30.9% vs 10.2% (p less than 0.05) and a mortality of 4.8% vs 0%. In conclusion, for esophageal, rectal and duodenal anastomoses staplers may be preferred, while for the intestinal anastomoses in non elective surgery hand-sutures should be preferred.

[Anorectal sphincter function after mechanical anterior resection in cancer of the rectum]. / La funzione sfinteriale ano-rettale dopo resezione anteriore meccanica per cancro del retto.

Out of a total of 365 operations for colo-rectal disease performed during the period 1980-1989 at the III and V Division of General Surgery of the 2nd Faculty of Medicine and Surgery of Naples, 181 (49.6%) patients had rectosigmoidal cancer: 95 (52.5%) underwent anterior resection and 86 (47.5%) Miles' operation. In 46 patients who underwent mechanical anterior resection during the period 1986-1989, pre and postoperative sphincter function was studied through a complete anamnesis, physical examination, sigmoidoscopy or colonoscopy and balloon manometry. All data were analyzed considering both the distance of the anastomosis from the anal verge and the patient age in order to stress possible relations with incontinence. The low incidence of incontinence registered after 12 months (6.5%), confirms the importance of manometry and rehabilitation, both necessary to improve the quality of life in old patients who undergo low anterior resection.

[Mechanical staplers in resective surgery of the pancreas]. / Le suturatrici meccaniche nella chirurgia resettiva del pancreas.

In this study 8 pancreatic resections were performed using the Autosuture stapler. No fistula developed among 5 cases of distal pancreatectomy, conversely 2 pancreatic fistula occurred in 3 cases of pancreaticoduodenectomy; one patient died for fistula. It is concluded that distal pancreatectomy with staplers is a reasonable and safe alternative to pancreaticojejunostomy, and may be preferred because of its facility and rapidity. Staple closure of the transected pancreas in pancreaticoduodenectomy doesn't seem to be so safe and further evaluation is needed.